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Biomedical subjects

Albert W Biglan

Publications and source records attributed to Albert W Biglan.

7 recordsLinked to original sources
PubMed2006

Visual acuity in children with glaucoma.

PURPOSE: To investigate the risk factors that influence outcome of visual function in children with glaucoma. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: One hundred twenty-six patients (204 eyes) who had childhood glaucoma observed over 30 years, with a mean follow-up of 11.6 years. INTERVENTIONS: Full ophthalmologic examination, including measurement of corrected visual acuity (VA), slit-lamp and fundus examinations, intraocular pressure (IOP) measurement, and gonioscopic evaluation; periodic cycloplegic refraction and perimetry; and treatment of amblyopia. MAIN OUTCOME MEASURES: Type of glaucoma; final best-corrected VA of good (6/6-6/12), fair (6/15-6/30), or poor (< or =6/60); patient age at time of development of glaucoma complications; and percentage of IOP measurements of < or =19 mmHg, perimetry results, and cup-to-disc (C/D) ratio during follow-up. RESULTS: The most recently measured VAs of children treated for glaucoma were good in 29%, fair in 24%, and poor in 47%. The most favorable outcome was for patients with primary infantile glaucoma followed by secondary glaucoma. Amblyopia and optic nerve damage due to glaucoma were the most frequent complications affecting VA. Patients with an IOP of < or =19 mmHg on 80% of determinations had stable optic nerve C/D ratios and visual fields. CONCLUSIONS: Vision sufficient to qualify for a motor vehicle driving license was attainable in almost 30% of affected eyes. Visual acuity achieved at 6 years of age remained stable over the study period. Treatment of amblyopia is important to achieve this result.

Adolescent↗
PubMed2006

Glaucoma in children: are we making progress?

BACKGROUND: Glaucoma in children presents difficult clinical challenges. Even when appropriately treated, blindness can occur. DESIGN: Retrospective interventional case series and literature review. METHODS: All clinical records of children seen by the author with a diagnosis of glaucoma established before 16 years of age were reviewed from 1977 to 2003. Glaucoma was classified as primary infantile, aphakic, syndrome-related, and secondary. The best-corrected visual acuity, refractive error, configuration of the optic nerve cup, and perimetry were recorded. The intraocular pressure (IOP) for each visit was recorded. IOP measurements of 19 mm Hg or less were considered "good." The percentage of "good" readings was calculated for each eye. Representative visual acuities, refractive errors, IOP, disk configuration, and perimetry were recorded at 6, 12, 18, and 24 years of age for each patient. The admitting ophthalmologic diagnosis for each child at the Western Pennsylvania School for Blind Children was recorded from 1887 to 2003. RESULTS: One hundred twenty-six children (204 eyes) were studied: infantile glaucoma, 52 eyes; aphakic glaucoma, 40 eyes; syndrome associated, 69 eyes; and secondary glaucoma, 43 eyes. The mean follow-up was 11.6 years (1 to 30 years). Overall, 60 (29.4%) of 204 eyes had a 6/12 (20/40) or better corrected visual acuity at the most recent visit. The percentage with this acuity remained stable throughout the follow-up period. Eyes with infantile glaucoma had the best acuity, and 40% had 6/12 (20/40) or better. Amblyopia was common and responded to treatment. Eyes with aphakic glaucoma had the worst acuity with only 10% achieving 6/12 or better. These eyes had a bimodal onset of glaucoma; eyes with an early onset had an angle closure configuration and eyes with a delayed onset had an open angle. Early cataract removal and microcornea were risk factors for glaucoma. If the IOP was maintained at 19 mm Hg or less (good) on 80% of the determinations over time, the optic nerve cup compared with the diameter of the optic nerve (C/D ratios) were stable. Eight patients had multiple, good quality, visual fields performed over 3 to 15 years. If the patients had "good" IOP on 70% of the measurements, the visual fields remained stable. A historical perspective of glaucoma control was gained by looking at the admitting diagnosis at the Western Pennsylvania School for Blind Children. From 1910 to 1970, an average of 9.2 children blind due to glaucoma were admitted each decade. From 1971 to 2003, there were only three children with glaucoma admitted over 30 years. CONCLUSION: Removal of congenital cataracts should be delayed until 3 to 4 weeks of age. Consideration should be given for using 19 mm Hg or less to measure the success of glaucoma treatment in children. Treatment of amblyopia is as important as IOP control in children. Imaging technology such as optical coherence tomography and measurement of central corneal thickness may play an important future role in the assessment of children with suspected or known glaucoma.

Child↗
PubMed2006

Comparison of delayed-onset glaucoma and early-onset glaucoma after infantile cataract surgery.

PURPOSE: To investigate the causes and characteristics of glaucoma in children following cataract surgery. METHODS: Twenty-four patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma after cataract surgery were studied retrospectively. Variables included cataract morphology, surgical techniques, post-operative complications, time to the onset of glaucoma, gonioscopic findings, presence of microcornea and the histopathologic characteristics of the filtration angle (in one case). RESULTS: There was a bimodal onset of glaucoma after cataract surgery. Early-onset glaucoma occurred at a mean age of 6 months in 15 eyes and delayed-onset glaucoma at a mean age of 12 years in 22 eyes. Early-onset glaucoma was significantly (p = 0.018) more likely to be due to angle closure than delayed-onset glaucoma. With delayed-onset glaucoma, the filtration angle was open in 86% of eyes and significantly (p = 0.006) more eyes in the delayed-onset group had microcornea. Medical treatment was sufficient to control intraocular pressure in the delayed-onset group while the early-onset group required surgical treatment (P < 0.001). CONCLUSIONS: The onset of glaucoma after cataract surgery during infancy follows a bimodal pattern that is correlated with the configuration of the filtration angle. The early-onset glaucoma group had high incidence of angle closure requiring surgical treatment, while in the delayed-onset group non-surgical treatment was sufficient to control intraocular pressure. Prophylactic iridectomy in eyes at risk for pupillary block is recommended. Eyes with delayed-onset glaucoma have open filtration angles yet also have findings of incomplete development of filtration structures. Microcornea is a risk factor for delayed-onset glaucoma.

Adolescent↗
PubMed2004

Graded partial tenotomy of vertical rectus muscles for treatment of hypertropia.

PURPOSE: To evaluate the effectiveness of graded (adjustable intraoperatively) partial vertical rectus muscle tenotomy at the insertion in correcting small degrees of hypertropia. METHODS: All patients with best-corrected visual acuity of better than 6/30 in both eyes who over a 30-month period underwent partial tenotomy of vertical rectus muscle(s) only (no concurrent oblique muscles) were included. Improvement was evaluated 6 weeks postoperatively as change in alignment in prism diopters (PD) in primary gaze and in the field of action of the affected rectus muscle(s). Binocular function was evaluated by Titmus stereoacuity and the Worth 4-light tests. RESULTS: All 24 patients who met criteria for inclusion had diplopia preoperatively versus seven patients (29%) postoperatively (P < .005, Student's paired t test). Prisms were used by six preoperatively versus two postoperatively (P < .05, Student's paired t test). The average vertical deviation in primary gaze decreased from 8 PD to 2 PD (P < .005, Student's paired t test). In the field of action of the treated rectus muscle, hypertropia decreased from an average of 8 PD to 3 PD (P < .005, Student's paired t test). For the preoperative and the postoperative assessments available, stereoacuity improved after 10 (56%) of the 18 procedures and Worth 4-light testing showed improvement or maintenance of fusion after 15 (79%) of 19 procedures. CONCLUSIONS: Graded vertical rectus partial tenotomy can effectively reduce small degrees of hypertropia and associated diplopia, improve binocular function, and reduce or eliminate the need for prism correction.

Depth Perception↗
PubMed2002

Risk factors for secondary membrane formation after removal of pediatric cataract.

PURPOSE: To evaluate the incidence of secondary membrane formation, factors that lead to its development, and the frequency of procedures to treat these membranes in children after cataract surgery. SETTING: Department of Pediatric Ophthalmology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA. METHODS: Clinical records of 152 patients (190 eyes) who had cataract extraction between January 1986 and 1996 were reviewed retrospectively. The mean follow-up was 6 years (range 2 to 13 years). Cataract surgery was performed through a limbal incision in all cases. Twenty-eight eyes had a primary posterior capsulectomy, and 120 eyes had posterior capsulectomy combined with an anterior vitrectomy. In 42 eyes, the posterior capsule was left intact. Nineteen eyes received a primary intraocular lens (IOL), 15 eyes received a secondary IOL, and 156 eyes were rehabilitated with spectacles or contact lenses. RESULTS: Seventy-two eyes (37.9%) developed secondary membrane a mean of 8.9 months postoperatively (range 3 weeks to 53 months). Membranes occurred in 78.6% of eyes with an intact posterior capsule, 42.9% with posterior capsulectomy, and 22.5% with combined posterior capsulectomy and anterior vitrectomy. Secondary membrane formation was associated with not performing a posterior capsulectomy with anterior vitrectomy (P < .001) and the presence of a primary IOL (P < .001). Younger age at surgery increased the chance of secondary membrane formation in patients who had posterior capsulectomy and anterior vitrectomy (P < .01). CONCLUSIONS: The younger the child at cataract surgery, the greater the risk of secondary membrane. Primary posterior capsulectomy combined with an anterior vitrectomy decreased but did not eliminate the incidence of secondary membrane.

Adolescent↗